Mucocele of the accessory nasal sinuses / by A. Logan Turner.

  • Turner, A. Logan (Arthur Logan), 1865-1939.
Date:
1907
Catalogue details

Licence: In copyright

Credit: Mucocele of the accessory nasal sinuses / by A. Logan Turner. Source: Wellcome Collection.

Provider: This material has been provided by The Royal College of Surgeons of England. The original may be consulted at The Royal College of Surgeons of England.

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    of the eyebrow, and when the soft parts were reflected downwards a clear serous-like fluid welled out. A large cavity, the right frontal sinus, had been opened into without the necessity of removing any bony wall. The fluid as it escaped pulsated markedly, as indeed did the whole eyeball. The frontal cavity passed for a very considerable distance upwards, also to the left across the mesial line, while its extension backwards along the roof of the orbit measured 1£ in. A considerable area of the bony floor of the sinus had been absorbed. The cerebral wall of the sinus also showed a large area—at least the size of half a crown—from which the bone had disappeared. The dura mater was plainly seen pulsating, a fact which accounted for the marked pulsation of the fluid contained in the frontal sinus. The lining membrane of the cavity was thin. It was decided to postpone for a few days the making of an opening into the nose. The sinus was therefore lightly packed with iodoform worsted. It was found necessary to change the dressings over the wound twice daily at first, owing to the copious flow of blood-stained fluid which saturated them. After an interval of eight days the patient was again anaesthetised, and a large opening was made between the sinus and the nasal cavity, a drainage tube being passed through the opening. The after-treatment of the case presented no special points of interest. The external wound was allowed to close after ten days. The tube was maintained in position for six weeks, and then removed through the nostril, the patient being instructed to wash out the sinus by means of a curved cannula. Six months after the operation she reported that there was no discharge from the nose, and that her eye was in good position. The fluid which escaped from the sinus in this case closely resembled in appearance cerebro-spinal fluid. Fehling’s test applied during the operation was negative. From a culture made on agar, the Staphylococcus pyogenes albus was obtained. No chemical report was, unfortunately, obtained, but the fluid pre- sented none of the physical characters of mucus. Case 3.—Mucocele of the right frontal sinus.—C. K., a female, set. 33, was admitted to the Ear and Throat Department on 18th April 1904, complaining of a more or less constant discharge from a small opening in the inner part of the right upper eyelid. The history obtained was as follows:—Eight years ago, in 1896, she had noticed a small swelling, the size of a pea, occupying the inner third of the right upper eyelid, just above the inner canthus. She did not suffer any pain; there was no discoloration of the skin; there was no nasal dis- charge. The swelling increased somewhat in size during the next three years, and some displacement of the eyeball was observed.. She then consulted her medical attendant, who incised it. A thickish non- purulent fluid was evacuated. The wound, however, did not heal. Six months later a free incision was made under chloroform, and the con-